Editing Steatorrhea (section)

==Causes==
Impaired digestion or absorption can result in fatty stools.
Possible causes include [[exocrine pancreatic insufficiency]], with poor digestion from lack of [[lipases]], loss of [[bile salts]], which reduces [[micelle]] formation, and small intestinal disease-producing [[malabsorption]]. Various other causes include certain medicines that block fat absorption or indigestible or excess oil/fat in diet.<ref name="StatPearls"/>

The absence of [[bile]] secretion can cause the feces to turn gray or pale. Bile is responsible for the brownish color of feces. In addition to this, bile also plays a role in fat absorption, where dietary lipids are combined so that pancreatic lipases can hydrolyze them before going towards the small intestine. Without bile acids, this pathway would have a hard time occurring, which would lead to fat malabsorption and make steatorrhea more probable to occur.<ref name="StatPearls"/> Other features of fat malabsorption may also occur such as reduced bone density, difficulty with vision under low light levels, bleeding, bruising, and slow blood clotting times.<ref name="Handbook"/>

===Associated diseases===
* Conditions affecting the [[pancreas]].  [[Exocrine pancreatic insufficiency]]<ref name="pmid24259956">{{cite journal |vauthors=Lindkvist B |title=Diagnosis and treatment of pancreatic exocrine insufficiency |journal=World J. Gastroenterol. |volume=19 |issue=42 |pages=7258–66 |year=2013 |pmid=24259956 |pmc=3831207 |doi=10.3748/wjg.v19.i42.7258 |type=Review |doi-access=free }}</ref> can be caused by chronic [[pancreatitis]], [[cystic fibrosis]] and [[pancreatic cancer]] (if it obstructs biliary outflow).<ref name="Handbook"/>
* Conditions affecting [[bile salts]].  Obstruction of the [[bile ducts]] by [[gallstones]] ([[choledocholithiasis]]), [[primary sclerosing cholangitis]], [[liver damage]] ([[hepatitis]], intrahepatic [[cholestasis]]), [[hypolipidemic]] drugs, or changes following [[gallbladder]] removal ([[cholecystectomy]]).<ref name="Handbook"/>
* Conditions producing intestinal [[malabsorption]].  These include [[celiac disease]], [[bacterial overgrowth]], [[tropical sprue]], [[giardiasis]] (a protozoan parasite infection), [[Zollinger-Ellison syndrome]], [[short bowel syndrome]], [[inflammatory bowel disease]] and [[abetalipoproteinemia]].<ref name="Handbook"/><ref name="pmid20626336">{{cite journal |last1=Moutzouri |first1=Elisavet |last2=Elisaf |first2=Moses |last3=Liberopoulos |first3=N. Evangelos |year=2011 |title=Hypocholesterolemia |journal=Current Vascular Pharmacology |volume=9 |issue=2 |pages=200–12 |doi=10.2174/157016111794519354 |pmid=20626336}}</ref>
* Other causes: Drugs that can produce steatorrhea include [[orlistat]], a slimming pill, or as adverse effect of [[octreotide]] or [[lanreotide]], used to treat [[acromegaly]] or other [[neuroendocrine tumors]].<ref>{{cite journal|last1=Dogliotti|first1=L|last2=Tampellini|first2=M|last3=Stivanello|first3=M|last4=Gorzegno|first4=G|last5=Fabiani|first5=L|title=The clinical management of neuroendocrine tumors with long-acting repeatable (LAR) octreotide: comparison with standard subcutaneous octreotide therapy|journal=Annals of Oncology|date=2001|volume=12|issue=Suppl 2|pages=S105–9|pmid=11762334|doi=10.1093/annonc/12.suppl_2.s105|doi-access=}}</ref>  It can be found in [[Graves' disease]] / [[hyperthyroidism]].<ref name="Handbook"/>

===Medications===
[[Orlistat]] (also known by trade names Xenical and Alli) is a diet pill that works by blocking [[Lipase|the enzymes that digest fat]]. As a result, some fat cannot be absorbed from the gut and is excreted in the feces instead of being metabolically digested and absorbed, sometimes causing oily anal leakage.<ref name=WP>{{cite news |first= Sally|last= Squires|title=Weighing a Pill For Weight Loss |url=https://www.washingtonpost.com/wp-dyn/content/article/2006/01/23/AR2006012301270.html |quote=While the Food and Drug Administration (FDA) still must approve the switch, the agency often follows the advice of its experts. If it does, Orlistat (xenical) -- currently sold only by prescription -- could be available over-the-counter (OTC) later this year. But it's important to know that the weight loss that's typical for users of the drug -- 5 to 10 percent of total weight -- will be less than many dieters expect. And many consumers may be put off by the drug's significant gastrointestinal side effects, including [[flatulence]], [[diarrhea]], and anal leakage. |newspaper=[[Washington Post]] |date= 2006-01-24|access-date=2007-07-06}}</ref><ref name=CSPI>{{cite news |title=Frito-Lay Study: Olestra Causes "Anal Oil Leakage" |url=http://www.cspinet.org/new/flaynal.html |quote=The Frito-Lay report states: "The anal oil leakage symptoms were observed in this study (3 to 9% incidence range above background), as well as other changes in elimination. ... Underwear spotting was statistically significant in one of two low-level consumer groups at a 5% incidence above background." Despite those problems, the authors of the report concluded that olestra-containing snacks "should have a high potential for acceptance in the marketplace." |publisher=[[Center for Science in the Public Interest]] |date=February 13, 1997 |access-date=2007-07-07 |archive-date=2016-06-18 |archive-url=https://web.archive.org/web/20160618195225/http://www.cspinet.org/new/flaynal.html |url-status=dead }}</ref><ref name=NW>{{cite news |title=The Word Is 'Leakage'. Accidents may happen with a new OTC diet drug. |url=http://www.msnbc.msn.com/id/19263093/site/newsweek/ |quote=GlaxoSmithKline has a tip for people who decide to try Alli, the over-the-counter weight-loss drug it is launching with a multimillion-dollar advertising blitz—keep an extra pair of pants handy. That's because Alli, a lower-dose version of the prescription drug [[Xenical]], could (cue the late-night talk-show hosts) make you soil your pants. But while Alli's most troublesome side effect, anal leakage, is sure to be good for a few laughs, millions of people who are desperate to take off weight may still decide the threat of an accident is worth it. |publisher=[[Newsweek]] |date=June 25, 2007 |access-date=2007-06-21 |url-status=dead |archive-url = https://web.archive.org/web/20070618160359/http://www.msnbc.msn.com/id/19263093/site/newsweek/ <!-- Bot retrieved archive --> |archive-date = 2007-06-18}}</ref> Vytorin (ezetimibe/simvastatin) tablets can cause steatorrhea in some people.<ref name=WP/><ref name=NW/>

===Excess whole nuts in diet===
Some studies have shown that stool lipids are increased when whole nuts are eaten, compared to nut butters, oils or flour<ref>{{cite journal  |last1=Traoret |first1=C J |last2=Lokko |first2=P |last3=Cruz |first3=A C R F |last4=Oliveira |first4=C G |last5=Costa |first5=N M B |last6=Bressan |first6=J |last7=Alfenas |first7=R C G |last8=Mattes |first8=R D |year=2007 |title=Peanut digestion and energy balance |journal=International Journal of Obesity |volume=32 |issue=2 |pages=322–8 |doi=10.1038/sj.ijo.0803735 |pmid=17912269|doi-access= |url=http://www.locus.ufv.br/handle/123456789/23410 |url-access=subscription }}</ref> and that lipids from whole nuts are significantly less well absorbed.<ref>{{cite journal |last1=Hollis |first1=James |last2=Mattes |first2=Richard |year=2007 |title=Effect of chronic consumption of almonds on body weight in healthy humans |journal=British Journal of Nutrition |volume=98 |issue=3 |pages=651–6 |doi=10.1017/S0007114507734608 |pmid=17445351|doi-access=free }}</ref>

===Natural fats===
Consuming [[jojoba oil]] has been documented to cause steatorrhea and anal leakage because it is indigestible.<ref>{{cite journal |pmid=1415629 |year=1992|last1=Place|first1=A. R.|title=Comparative aspects of lipid digestion and absorption: Physiological correlates of wax ester digestion|journal=The American Journal of Physiology|volume=263|issue=3 Pt 2|pages=R464–71|doi=10.1152/ajpregu.1992.263.3.R464}}</ref>

Consuming [[escolar]] and [[oilfish]] (sometimes mislabelled as [[Sablefish|butterfish]]) will often cause steatorrhea, also referred to as gempylotoxism or gempylid fish poisoning or [[keriorrhea]].<ref>[[Bad Bug Book]] - Foodborne Pathogenic Microorganisms and Natural Toxins Handbook: [https://web.archive.org/web/20090611062250/http://www.fda.gov/Food/FoodSafety/FoodborneIllness/FoodborneIllnessFoodbornePathogensNaturalToxins/BadBugBook/ucm071191.htm Gempylotoxin], [[Food and Drug Administration|FDA]]</ref>

===Artificial fats===
The fat substitute [[Olestra]], used to reduce digestible fat in some foods, was reported to cause leakage in some consumers during the test-marketing phase. As a result, the product was reformulated before general release to a hydrogenated form that is not liquid at physiologic temperature. The U.S. [[Food and Drug Administration]] warning indicated excessive consumption of Olestra could result in "loose stools"; however, this warning has not been required since 2003.<ref name=CSPI/><ref name=CSPI2>{{cite news |title=Reported medical side-effects of Olestra according to Procter and Gamble studies |url=http://www.cspinet.org/olestra/11cons.html |quote=Olestra sometimes causes underwear staining associated with "anal leakage." Olestra sometimes causes underwear staining. That phenomenon may be caused most commonly by greasy, hard-to-wipe-off fecal matter, but occasionally also from anal leakage (leakage of liquid olestra through the anal sphincter). |publisher=[[Center for Science in the Public Interest]] |access-date=2007-06-21 |url-status=dead |archive-url=https://web.archive.org/web/20070702223802/http://www.cspinet.org/olestra/11cons.html |archive-date=2007-07-02 }}</ref>